Maximising the potential of reablement

The importance of goal-setting

Overview

Successful reablement depends on the development of person-centred goals toward which people will work with the support of the reablement service. Although there is no single tool for goal-setting in reablement there are certain principles that should underpin the process.

Goal-setting is essential to the success of reablement. There is no single universally accepted tool for goal-setting, although focusing on people’s strengths and what they want to be able to do is a good basis for the process.

Recommendations

Having established people’s needs and strengths, goal-setting involves three main steps: identifying an end point (the goal or achievement), working out what steps are needed to reach that end point and, finally, establishing what structures must be in place to facilitate goal attainment.

Occupational and physiotherapists play a fundamental role in goal-setting. They should either be deployed to carry out this task or train reablement workers to carry it out themselves. Please see the section on the skills mix in a reablement service.

The ‘SMART’ principles also provide a useful guide to goal-setting. SMART goals are:

Specific – it’s easier to accomplish a specific goal than a general one. For example, ‘re-join my old lunch club and attend twice a week’.

Measurable – there should be concrete criteria for measuring progress toward the attainment of goals.

Attainable – when people identify goals that are really important to them (e.g. ‘be able to cook Sunday lunch for my family again’) they are more likely to develop the attitudes and ability to reach them.

Realistic – goals should represent an objective that people are willing and able to work toward. They should also be set at a sufficiently high level that they represent real progress. Of course, progress is relative.

Timely – goals should be grounded within a time frame (e.g. ‘by the end of the week I will be able to button my own cardigan’).

Although the SMART principles provide a good framework, they should be applied in a way that is responsive to each individual’s needs. Above all, goals must be person-centred and developed with as much participation as possible by the individual.

Goals are a joint undertaking between the individual and the reablement service. Having a written agreement, signed by both parties, is one way of formalising people’s commitment to achieving goals.

Where appropriate, the individual’s family and friends should also be involved in goal-setting. Any conflicting or opposing views about suitable goals must be negotiated sensitively and with professional judgement.

The concept of independence is often central to goal-setting. However, there is no single, standard definition of independence.

Recommendations

It is important to acknowledge that an individual’s definition may be very different to the way a professional would define independence.

It is therefore crucial that reablement managers and frontline workers have a clear understanding of the individual’s priorities and the aspects of their life they believe are central to feeling ‘independent’. If the person’s own aspirations and definition of ‘successful’ reablement are not clearly understood, there is a risk they will become demoralised when they see they are not being helped to achieve their personal goals.

Whether goals have been formally ‘signed up’ to or simply discussed and agreed, they should be constantly reiterated throughout the period of reablement.

Although goal-setting is very important, working toward those goals must be done in a flexible, responsive way. During a person’s recovery there are bound to be fluctuations in their health and social circumstances. Although a reablement worker may normally encourage someone to perform their personal care or cooking they may need to provide more hands-on help in the event of illness or a deterioration in that person’s condition.

If progress toward goals is completely stalled there should be a full review of the person’s needs. Goals may need to be redefined and support levels may need to be adjusted.

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